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An Informative Guide to Gender Confirmation

Posted by Weiss Memorial Hospital on Jun 28, 2019 11:40:00 AM

Gender affirmation surgery is an important step for some individuals.  These procedures are designed to assist some transgender and gender diverse individuals to fully embrace their authentic self. 

Surgery is not for everyone, and is not a necessary aspect of gender expression or gender identity. Each person is an individual, and surgery may be right for some, but not for others.

Deciding to undergo gender affirmation surgery is a big decision. Whether you’re just starting to explore these options or have already decided that it’s right for you, this article will provide you with some basic information.

gender affirmationGender is a Spectrum, Not a Linear Scale

Images such as the Gender Unicorn can help to explain one’s own gender identity, sexual attraction and expression as well as to educate family and friends who may not yet understand these concepts. There are several aspects to gender that better clarify how this works.  

Gender identity is the personal sense of one’s own gender whether that is male, female, another gender, or neither gender. Gender can also be fluid and change over time. Gender expression is one’s choice to express themselves as feminine, masculine, other, or neither. 

Biological sex is the sex that one is assigned at birth, which may or may not correspond with one’s gender expression and/or identity. Also included in the Gender Unicorn graphic are physical and emotional attractions. This can incorporate attraction to men, women, both genders, or another gender. 

In some cases, individuals may wish to surgically change their body to accommodate the gender that feels more authentic to their true identity. At Weiss Memorial Hospital, our staff provides inclusivity of care to all patients on the gender spectrum. Our compassionate team will help you feel accepted and respected every moment of your journey. 

See a Gender Affirmation Specialist

Many surgeons are qualified to perform breast, gynecological, or urological surgeries. However, for individuals desiring transfeminine or transmasculine procedures, finding a specialist in these areas is a must! 

Special considerations and preparations must be taken into account before proceeding with surgery. Only a surgeon with this type of expertise is qualified to produce satisfactory results with fewer post-surgical complications.     

The surgeries can be divided into two broad categories: transfeminine and transmasculine procedures. Transfeminine surgeries allow individuals to express their gender in a feminine way; transmasculine surgeries allow expression of gender in a masculine way.  You should choose a surgeon who can accommodate your individualized needs for affirmation.

In some cases, hormone therapy may be used prior to or after surgery is performed.  If you have questions about whether hormone therapy is right for you, a gender affirmation specialist can offer guidance. 

gender confirmation surgeryTransfeminine Surgery Options

Vaginoplasty

Also referred to as “bottom surgery,” this procedure is designed to create a vaginal opening and, if desired a vaginal canal.  Two different surgical techniques can be used. 

The first type is called a penile inversion vaginoplasty. This procedure transforms penile tissue (shaft of the penis) into a functional new vagina. The tip of the penis is used to form the new clitoris. The benefit of using the tip of the penis is that the sensitive nerve tissue is preserved, allowing for sexual pleasure to be maintained.  

The second type of vaginoplasty involves using part of the intestine to construct a vaginal canal. This type of vaginoplasty has an advantage in that the mucosal glands of the intestine may allow for a self-lubricating new vagina.  Disadvantages of this procedure are that it is more invasive, lubrication of the vagina may have a foul smelling odor, and that it does not eliminate the need for dilation following surgery.

Breast Augmentation

This is also known as “top surgery.” This procedure uses breast implants (saline or silicone) to create breasts. Patients can choose the desired size and shape. Implants may be placed under or over the pectoral muscle and may involve an incision in the breast crease, around the areola (nipple) or in the axilla (armpit).  Incision placement is often dictated by your individual body type.   

Facial Feminization

Facial feminization surgery is another option for transgender and gender diverse patients. This set of procedures can be performed in stages. For some individuals, however, only one or several procedures may be desired.

Facial feminization surgeries may include focus on the:

  • Hairline
  • Forehead
  • Brow line
  • Cheeks
  • Nose
  • Jawbone
  • Chin
  • Lips
  • Neck (Adam’s apple)

transmasculineTransmasculine Surgery Options

Just as with transfeminine procedures, there is a range of “top” and “bottom” surgical options. The procedures can coincide with those that most authentically align with an individual’s gender identity and gender expression.

Metoidioplasty

Also known as “meta”, this is a procedure in which a penis and scrotum are created. Individuals have the option to include or exclude urethral lengthening. Those who choose urethral lengthening may have the ability to urinate while standing up. 

The advantages of metoidioplasty include minimal scarring and a shorter recovery time as compared to a phalloplasty. The disadvantage is that this procedure does not allow for a penile prosthesis, which means penetration during intercourse may not be possible.  It is important to note that a metoidioplasty can be turned into a phalloplasty at a later time if an individual chooses. This makes the healing process more manageable and improves the outcome for future phalloplasty.

Note: In some cases, hormone treatment and social transition are recommended, but this may depend on insurance coverage. One year of hormone therapy can provide a surgical benefit when having a metoidioplasty because of its ability to masculinize the clitoris. 

Phalloplasty

This surgical procedure consists of two or three phases and is designed to create a functioning penis. Phalloplasty with urethral lengthening a penile prosthesis allows individuals to urinate standing up as well as to penetrate during sexual intercourse. 

Tissue and nerves can either be taken from the thigh (anterolateral thigh flap phalloplasty), or forearm (radial forearm phalloplasty).  Nerves from the skin are incorporated along the shaft of the phallus, while nerves from the clitoris are preserved to allow for sexual pleasure.  Blood supply is brought to the new penis by blood vessels that have been grafted to the area.

A scrotum may be constructed, and testicular implants may be placed in a follow-up surgery.  The advantage of phalloplasty is the ability to have a fully functioning penis. The disadvantages are a longer recovery time, higher complication rates, a visible donor site and the potential need for secondary procedures to fine-tune the results. 

Chest Contouring

Chest contouring also known as “top surgery” involves the removal of breast tissue and repositioning of the nipple and areola (when needed). There are two types of chest contouring procedures:

  • Limited incision - best for individuals who do not need any skin removed and have a small amount of breast tissue to be removed. 
  • Double incision - best for individuals who need large amounts of breast tissue and skin removed as well as repositioning of the nipple and areola.

deciding on gender confirmationHow to Make the Decision

Making the decision to affirm your gender through surgery is personal. There is no right or wrong answer. Some individuals choose to have both “top” and “bottom” while others may choose one surgery. 

If you are interested in gender affirmation surgery, it is important to speak with a specialist who has expertise in this area. A gender confirmation expert can:

  • Explain the details of each procedure
  • Address any questions and concerns
  • Evaluate your unique situation

Some important aspects of your surgical plan may include discussion of:

  • Puberty suppression 
  • Hormone therapy
  • Full hysterectomy (removal of uterus, ovaries, and fallopian tubes)
  • Partial hysterectomy (removal of the uterus)
  • Bilateral oophorectomy (removal of both ovaries) 
  • Bilateral orchiectomy (removal of both testicles)
  • Fertility options after surgery

Your gender confirmation specialist can make sure that all of the proper steps have been taken to ensure that your gender affirmation process is a success.

Weiss Memorial Hospital: The Expert Gender Confirmation Specialists

The compassionate team at The Center for Gender Confirmation at Weiss Memorial Hospital understands the importance of staying true to yourself. Only a handful of centers in the United States offer comprehensive gender-related medical services, and we are here to help you every step of the way. 

Loren S. Schechter, MD, FACS, offers the full spectrum of gender affirmation surgeries at Weiss Memorial Hospital. He is a Board Certified Plastic Surgeon and a member of many nationally recognized medical and professional associations. Meet Dr. Schechter and our team.

He serves as a board member for the World Professional Association for Transgender Health (WPATH), and is the author of the first surgical atlas describing gender affirming surgery techniques.  

Contact us today to schedule your initial consultation and begin your journey

Topics: Gender Confirmation

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